الفهرس 
INTRODUCTION
HAIs in hematological malignanciesOnly 14 pages are availabe for public view
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Abstract
HAI problem is an important public health concern, often associated with considerable morbidity and mortality, prolonged hospitalization, and increased costs.
Infection remains a major complication in hematological malignancies. About 80% of patients with acute leukemia, 75% of patients with lymphoma, and 50% of patients with multiple myeloma develop infection during the course of their disease, and infection is the proximate cause of death in a substantial fraction of these patients.
HAIs are due to different types of organisms and these are increasing in their resistance to antibiotics. The treatment of these infections is one of the most difficult processes to help cure of those patients.
Infection control measures especially hand hygiene are crucial in preventing HAIs. It was proved that increase hand hygiene adherence rates is associated with a decrease in HAIs incidence rates.
The present study aimed at estimating the incidence of HAIs (identify bacterial profile and perform antibiogram of isolated strains) among adult hematology-oncology patients before and after implementation of the proper hand hygiene for all HCWs in the hematology unit dealing with those immnunocompromised patients.
The present study is a Quazi experimental study which was carried out on the patients admitted between May 2010 and October 2010 to the adult Hematology/Oncology unit (male section), Alexandria Main University Hospital, Egypt.
The study was divided into 2 phases 3 months each, during which 66 adult hematology-oncology male patients developed 92 infectious episodes. The CDC criteria were used as a standard definition for HAIs.
The results of this study revealed that:
In conclusion, HAIs especially nFUO are common problems in adult hematology/oncology patients especially with neutropenia. Infections, predominantly via blood stream, caused by Gram-positive organisms show significant multi-drug resistance with a high incidence of MRSA and Gram negative show ESBL resistance.
1- Acute hematological malignancies were more common among patients suffering from HAIs and the highest percentage of infectious episodes (67.4%) was among AML patients.
2- Although, the overall percentage of HAIs per 100 admissions was decreased from 28.9% during the first phase to 26.2% during the second phase, the result was not statistically significant.
3- The sites of HAIs were mostly BSIs 82.6%, and pneumonia 13%.
4- There was a predominance of the Gram-positive cocci which represented 52%, Gram- negative bacilli represented 44 % of isolates while Candida .spp represented 4%.
The most common isolate overall was CNS (30%) followed by S. aureus (22%) and P.aeruginosa (14%).While K.Pneumoniae, E.coli and A.baumannii represented 8 % each, followed by Citrobacter spp 6%.
5- Primary BSIs were associated with no microbial growth (nFUO) in 57.9% episodes while 32 (42.1%) were laboratory confirmed due to single bacterial isolates in 28 (36.8%), Candida spp. and mixed bacterial isolates each in 2 (2.6 %) blood stream infectious episodes. CNS were the most common isolated organism from blood stream (40.6%), followed by S.aureus (12.5%), E.coli and P.aeruginosa (9.4% each), then Citrobacter spp and A.baumanii (6.3% each). The least isolated organism was K. pneumonia (3.1%).
6- The percentage of mortality in the first phase was 55.9% and in the second phase was 31.3%.
7- Regarding the antibiotic resistance, >90% of S.aureus were MRSA and all K.pneumoniae spp and E.coli isolates were ESBL +ve.
8- Regarding hand hygiene, the total compliance of the HCWs increased from 18.8% before the intervention to 41% after it.
The physicians’ compliance was raised from 20% before to 33.6 % after the intervention, and that of nurses was raised from 17.7% before to 48% after the intervention.
9- Moreover, the ABHR used in the present study showed a bacterial colony count reduction from the finger tips of the hands of HCWs from 7.5% - 71.4%.
It can be concluded from this study that:
1- Blood stream infection and fever of unknown origin are the most common HAIs in adult hematology/oncology patients with a higher risk during neutropenic days.
2- Isolated organisms are multi-drug resistant, predominantly Gram-positive pathogens with an incidence of MRSA, ESBLs and multidrug resistant P.aeruginosa.
3- from the available evidence it appears that multimodal interventions are the most suitable strategy to determine behavioral change leading to improved hand hygiene compliance and reduction in HAIs rates.